Slowing Nearsightedness

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If you’re nearsighted and of a certain age, the vision care of your youth probably went like this: Someone noticed you squinting at school. Off you went to the eye doctor who likely told your parents it was genetic and had nothing to do with your TV time or reading. You got your first glasses and your eyes got progressively worse over the years. That meant stronger and stronger lenses until they stabilized as an adult.

You sure aren’t alone. Myopia has become an epidemic. By 2050, estimates say half the world’s population will be myopic, says visual development expert Jasleen Jhajj, a pediatric optometrist and assistant professor of pediatrics and binocular vision at Nova Southeastern University’s College of Optometry.

Glasses provide clear vision but don’t slow myopia. In childhood myopia, the eye becomes too elongated from front to back, grows too quickly and continues growing after reaching full adult size. The elongated eye raises the risk of early cataracts, glaucoma, retinal detachment and other ills.

If both parents are myopic, a child’s chance of being myopic is 50%. But there also is an interplay of environment, lifestyle and genetics. “It’s just a breakdown of normal development,” Jhajj says.

For upcoming generations, the last 15 years have produced a slew of research and ways to intervene and slow progression of the condition.

Jhajj leads the Myopia Control Clinic, which celebrated its first anniversary in May, at the Eye Care Institute at NSU. “We’re really at the forefront now in these interventions,” she says.

For parents, the first thing to do is get the kids outdoors at least two hours a day. “Outdoor play is absolutely No. 1,” she says. “I’m always encouraging my kiddos to play. It’s how I end every conversation in our Myopia Control Clinic.” The sun offers the full spectrum of natural light, which activates dopamine which lets the eye develop normally. Indoor lighting, with its narrow spectrum, isn’t equivalent.

When myopia is identified, Jhajj believes in early intervention. (Once the kids are older, the eye damage is done.) Researchers have found that atropine eyedrops, when given daily to children in a diluted form, release dopamine and control eye growth in a healthy way. “We can’t cure a person with myopia, but we certainly can slow it down,” Jhajj says. The ultimate eyeglass prescription can be cut by as much as half. Jhajj has seen progression stop entirely for some.

She also recommends specialty myopia-control contacts — soft or hard.

Soft myopia-control daytime contacts are worn at least six days a week, 10 hours a day. Contacts mean better eye-hand coordination, peripheral vision and vision in general. Early on, concerns about proper lens hygiene and infection kept the very young from getting contacts. Turns out, their infection risk is lower if they use daily replacement lenses or parents take care of cleaning and hygiene. Children in early elementary grades deal with them successfully.

“The No. 1 factor is motivation,” she says. All myopia-control contacts work by blocking the signal that causes the eye to elongate.

Orthokeratology rigid contact lenses are hard contacts worn at night — the hard lens reshapes the cornea while children sleep — and are removed during the day. It allows children to have clear vision during the day without wearing glasses or contacts. It works well for swimmers — you shouldn’t swim in contacts — and other athletes.

An option in Canada and the United Kingdom that came out of Asia, where it's widely used, is a new type of eyeglass lens. Though not yet approved in the U.S., it focuses vision in a way said to be superior to traditional glasses.

What about all the screen time and “near work” at school that kids put in? Jhajj says scientific research on its contribution to myopia has been mixed. She recommends good lighting, keeping reading materials at least elbow length away — kids and adults tend to hold small objects like phones close to the face — and following the 20/20/20 rule: Every 20 minutes, take a 20-second break to look at something 20 feet away.

Jhajj herself is myopic and getting contacts changed her life. “I’m very passionate about myopia control,” she says. “There wasn’t much you could do when I was a kid. There’s finally a way we can treat this.” 

Florida’s Kids: Key Health Indicators

• 7.5% Uninsured children
• 30.4% Overweight or obese middle and high school students
• 5.9 per 1,000 live births Infant mortality rate
• 28.6 per 100,000 Child mortality rate (ages 5-19)
• 93.5% Immunization levels in kindergarten
• 17.1% Children struggling with food insecurity
• 594.9 per 100,000 Children (ages 5-11) experiencing child abuse
• 16.6% Students (K-12) absent 21 or more days from school
• 186.5 per 100,000 Juvenile drug arrests
• 2.3% Cigarette smokers among high school students

Tags: Healthcare, Pediatrics, Feature